Dialysis Diet

GENERAL INFORMATION:

What is a dialysis diet?

• You will need to follow a dialysis diet if you are getting dialysis (deye-AL-i-sis) treatment. The dialysis machine removes wastes from your blood when your kidneys cannot do this job. These wastes come from the foods you eat. Wastes slowly build up in your blood between your dialysis treatments. You can decrease the amount of these wastes by following the dialysis diet.
  
  
• A dialysis diet controls the amount of potassium, phosphorus, sodium and liquid in your diet. The dialysis diet also provides you with enough calories and protein to be healthy. Your caregiver will help you plan a diet with the right amount of phosphorus, potassium, sodium, fluid, and other nutrients for you. If you need peritoneal (per-I-toh-NEE-al) dialysis, your diet may not be as limited as a person who needs hemodialysis (he-mo-deye-AL-I-sis). Your diet may need to change over time based on your weight, blood test results, and other reasons.
  
  
• You may also need to make other diet changes if you have other health problems. These health problems may include diabetes, heart disease, high blood pressure and other health conditions.

What can I do to make a dialysis diet part of my lifestyle? Changing what you eat and drink may be hard at first. Following a dialysis diet may help you feel better. Think of these changes as "lifestyle" changes, not just "diet" changes. You will need to make these changes part of your daily routine.

• Choose a variety of foods on this diet to avoid getting tired of having the same foods every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet.
  
  
• Carry a list of items allowed on this diet to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can help you follow the diet.
  
  
• Ask your caregiver, a dietitian, or a nutritionist any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you.

What can I eat and drink while on a dialysis diet?

• You may eat ____ milligrams (mg) of potassium each day.
  
  
• You may eat ____ mg of phosphorus each day.
  
  
• You may eat ____ mg of sodium each day.
  
  
• You may drink ____ ounces or milliliters (mL) of liquid each day.
  
  
• Eat ____ grams of protein each day.

Milk and dairy products: The following servings of food have four grams of protein, 120 calories, 80 mg of sodium, 185 mg of potassium, and 110 mg of phosphorus.

• One half of a cup of milk (fat free, low-fat, whole, buttermilk, or chocolate milk).
  
  
• One-half of a cup of ice milk or ice cream.
  
  
• One-half of a cup of plain or fruit-flavored yogurt.
  
  
• Nondairy milk substitutes: These foods have one-half of a gram of protein, 140 calories, 40 mg of sodium, 80 mg of potassium, and 30 mg of phosphorus.
  
  
  • One-half of a cup of nondairy frozen dessert, or nondairy frozen dessert topping.
    
    
  • One-half of a cup of nondairy creamer.

Meat and meat substitutes: These foods have 7 grams of protein, 65 calories, 25 mg of sodium, 100 mg of potassium, and 65 mg of phosphorus. Do not use salt when preparing these foods.

• One ounce of beef, such as round, sirloin, T-bone, porterhouse steak, rib, ground beef or ground chuck.
  
  
• One ounce of pork such as fresh ham, tenderloin, chops, loin roasts, or cutlets.
  
  
• One ounce of lambchops, legs, or roasts.
  
  
• One ounce of poultry, such as chicken, turkey, Cornish hen, domestic duck, or goose.
  
  
• One ounce of any fresh and frozen fish.
  
  
• One ounce of lobster, scallops, shrimp, or clams.
  
  
• One and one-half ounces of crab or oysters.
  
  
• One ounce of canned tuna, unsalted canned salmon, or unsalted sardines.
  
  
• One large whole egg, or two large egg whites or yolks.
  
  
• One-fourth of a cup of low-cholesterol egg product.
  
  
• The following meats and meat substitutes are high in sodium. This means that they have 100-300 mg of sodium in a serving. You may need to avoid eating the following meats:
  
  
  • One ounce of deli-style roast beef, boiled or deli-style ham, or deli-style chicken or turkey.
    
    
  • One ounce of canned salmon or sardines.
    
    
  • One-fourth of a cup of cottage cheese.
  
  
• The following meats and meat substitutes are high in sodium, phosphorus, or saturated fat. These foods should be avoided in your diet:
  
  
  • All cheeses except cottage cheese.
    
    
  • Frankfurters, bratwurst, Polish sausage, and bacon.
    
    
  • Lunch meats including bologna, liverwurst, picnic loaf, salami, summer sausage.
  
  
• The following meats and meat substitutes are high in potassium and phosphorus. These foods should be avoided:
  
  
  • Nuts and peanut butter.
    
    
  • Dried beans, peas, and lentils.

Starches: These foods have 2 grams of protein, 90 calories, 80 mg of sodium, 35 mg of potassium, and 35 mg of phosphorus.

• Breads and rolls:
  
  
  • One slice of bread (French, Italian, raisin, light rye, or sourdough white).
    
    
  • One-half of a hamburger or hot dog bun.
    
    
  • One-half of a small Danish pastry or sweet roll, without nuts.
    
    
  • One small dinner roll or hard roll.
    
    
  • One-half of an plain English muffin, or one-half of a small plain bagel.
    
    
  • Two, six inch corn or flour tortillas.
  
  
• Cereals and grains:
  
  
  • Three-fourths of a cup of most brands of ready-to-eat cereal. (Some cereals are high in sodium).
    
    
  • Two cups of puffed rice.
    
    
  • One-half of a cup of cream of rice, cream of wheat, farina, or cooked grits.
    
    
  • One-third of a cup of oat bran or oat meal.
    
    
  • One-half of a cup of cooked pasta such as noodles, macaroni, or spaghetti.
    
    
  • One-half of a cup of cooked brown or white rice.
  
  
• Crackers and snacks:
  
  
  • Four saltine or round butter crackers.
    
    
  • Four graham crackers.
    
    
  • One and one-half cup of plain popped popcorn.
    
    
  • Nine tortilla chips. (This equals three-fourths of an ounce.)
    
    
  • One-fourth of an ounce of sticks or ring pretzels. (Salted pretzels are high in sodium.)
  
  
• Desserts:
  
  
  • Two inch square, or one and one-half ounces of cake.
    
    
  • Four sandwich cookies. (These cookies are high in sodium and phosphorus).
    
    
  • Ten vanilla wafers.
    
    
  • One-eighth of an apple, berry, cherry, or peach fruit pie.
    
    
  • One-half of a cup of sweetened gelatin.
  
  
• The following are starches that are high in low-quality protein and phosphorus. Do not eat these foods often. If you do eat them, eat only small amounts.
  
  
  • Bran cereal or muffins, granola cereal or bars.
    
    
  • Boxed, frozen, or canned meals, entrees (main courses), or side dishes.
    
    
  • Pumpernickel, dark rye, whole-wheat or oatmeal breads.
    
    
  • Whole-wheat crackers or cereals.

Vegetables: These foods have 1 gram of protein, 25 calories, 15 mg of sodium, and 20 mg of phosphorus. The amount of sodium listed is for vegetables that are canned or prepared with no added salt. One serving is one-half cup, unless another amount is given.

• Low potassium (0-100 mg):
  
  
  • One cup of alfalfa sprouts.
    
    
  • Green or wax beans, and bean sprouts.
    
    
  • Raw cabbage.
    
    
  • Peeled cucumber.
    
    
  • All varieties of lettuce (one cup).
    
    
  • One green, sweet pepper.
  
  
• Medium potassium (101-200 mg):
  
  
  • Five spears of asparagus.
    
    
  • Broccoli, cauliflower, eggplant, and onions.
    
    
  • One small raw carrot, or one stalk of raw celery.
    
    
  • One-half of a cup, or one-half of an ear of corn.
    
    
  • Fresh and canned mushrooms. (Mushrooms have 40 mg of phosphorus or more, per serving.)
    
    
  • Green or snow peas. (Peas have 40 mg of phosphorus or more, per serving.)
    
    
  • Raw spinach.
    
    
  • Summer squash.
  
  
• High potassium (201-350 mg):
  
  
  • Artichoke, or cooked celery.
    
    
  • One-fourth of a whole avocado.
    
    
  • One chili pepper.
    
    
  • Unsalted or regular vegetable juice cocktail. (Regular vegetable juice cocktail is high in sodium.)
    
    
  • Unsalted or regular tomato juice. (Regular tomato juice is high in sodium.)
    
    
  • One-fourth of a cup of tomato sauce.
    
    
  • One medium tomato.
  
  
• High Potassium (201-350 mg) and more than 40 mg of phosphorus:
  
  
  • Brussels sprouts or okra.
    
    
  • Potato, boiled, mashed.
    
    
  • Two tablespoons of tomato paste.
    
    
  • Fresh, cooked mushrooms.
    
    
  • Winter squash.
  
  
• Very high potassium (more than 350 mg):
  
  
  • Hash browned potato.
    
    
  • Sweet potato. (Sweet potatoes have 40 mg of phosphorus or more, per serving.)
    
    
  • One-fourth of a cup of beet greens.
    
    
  • One-half of a medium baked potato.
    
    
  • One ounce of potato chips (one ounce equals about 14 chips).
    
    
  • Cooked spinach. (Cooked spinach has 40 mg of phosphorus or more, per serving.)

Fruits: These foods have one-half gram of protein, 70 calories, and 15 mg of phosphorus. Each serving is one-half cup, unless another amount is given.

• Low potassium (0-100 mg):
  
  
  • Applesauce.
    
    
  • Blueberries.
    
    
  • One cup of cranberries or cranberry juice cocktail.
    
    
  • Canned pears.
    
    
  • Grape juice.
  
  
• Medium potassium (101-200 mg):
  
  
  • One small apple (two and one-half inches across) or apple juice.
    
    
  • One fresh peach (two inches across).
    
    
  • Sweet or sour cherries.
    
    
  • Canned or fresh pineapple or fruit cocktail.
    
    
  • Grapes, strawberries, mango, or watermelon.
    
    
  • One-half of a small grapefruit, or grapefruit juice.
    
    
  • One tangerine (two and one-half inches across).
  
  
• High potassium (201-350 mg):
  
  
  • One cup of canned or fresh apricots or five dried apricots.
    
    
  • One small nectarine (two inches across).
    
    
  • One-half of a cup of orange juice, or one small orange.
    
    
  • One-eighth of a small cantaloupe.
    
    
  • One-fourth of cup of dates or two whole dried figs.
    
    
  • One medium fresh pear.
    
    
  • One-eighth of a small honeydew melon.
  
  
• Very high potassium (more than 350 mg):
  
  
  • One-half of a medium banana.
    
    
  • Prune juice, dried prunes, or canned prunes.

Fats: These foods have very little protein, 45 calories, 55 mg of sodium, 10 mg of potassium, and 5 mg of phosphorus.

• Unsaturated fats:
  
  
  • One teaspoon margarine or one tablespoon reduced calorie margarine.
    
    
  • One teaspoon mayonnaise or one tablespoon low-calorie mayonnaise.
    
    
  • One teaspoon oil: safflower, sunflower, corn, soybean, olive, peanut, canola.
    
    
  • Two teaspoons salad dressing, mayonnaise type.
    
    
  • One tablespoon salad dressing, oil type.
    
    
  • Two tablespoons low-calorie salad dressing.
    
    
  • One and one-half teaspoons tartar sauce.
  
  
• Saturated fats:
  
  
  • One teaspoon butter.
    
    
  • Two tablespoons coconut.
    
    
  • One tablespoon powdered coffee whitener.
    
    
  • One teaspoon solid shortening.

High-calorie foods: These foods have very little protein, 100 calories, 15 mg of sodium, 20 mg of potassium, and 5 mg of phosphorus.

• Liquids: (Be sure to include these liquids when adding up the amount of liquids allowed for a day.)
  
  
  • One cup of a soda-type liquid: Ginger ale, lemon-lime.
    
    
  • One cup of a fruit-flavored drink, limeade, or lemonade.
    
    
  • One cup of cranberry juice cocktail.
  
  
• Frozen deserts: (Be sure to include these liquids when adding up the amount of liquids allowed for a day.)
  
  
  • One-half of a fruit ice bar.
    
    
  • One three ounce juice bar.
    
    
  • One-half cup of sorbet.
  
  
• Candy and sweets:
  
  
  • Four pieces of hard candy.
    
    
  • Ten jelly beans.
    
    
  • Two fruit rolls.
    
    
  • One-fourth cup of cranberry sauce or relish.
    
    
  • Five large marshmallows.
    
    
  • Two tablespoons brown or white sugar, marmalade, jam or jelly, syrup, honey.

Salty foods: These foods have 250 mg of sodium.

• One-eighth of a teaspoon of seasoned salt such as onion or garlic salt.
  
  
• Two tablespoons of barbecue sauce.
  
  
• One and one-half tablespoons of ketchup.
  
  
• One and one-half tablespoons of chili sauce.
  
  
• One-sixth of a large dill pickle.
  
  
• Four teaspoons of mustard.
  
  
• Two medium green olives or three large black olives.
  
  
• One-fourth of a teaspoon of soy sauce.
  
  
• Two and one-half teaspoons of steak sauce.
  
  
• One and one-fourth teaspoons of teriyaki sauce.

Liquids:

• These liquids may be included in your diet. Be sure to include these liquids when adding up the amount of liquids allowed for a day.
  
  
  • Non-cola sodas (ginger ale, lemon-lime sodas).
    
    
  • Ice.
    
    
  • Lemonade or limeade.
    
    
  • Water or mineral water.
  
  
• These liquids have some potassium or phosphorus in them. Avoid these liquids, or drink only small amounts.
  
  
  • Colas and pepper-type sodas.
    
    
  • Beer and wine.
    
    
  • Coffee, regular or decaffeinated.
    
    
  • Fruit-flavored drinks with added vitamin C.
    
    
  • Tea.
    
    
  • Thirst-quencher liquids.
  
  
• These liquids are very high in sodium or potassium and should be avoided.
  
  
  • Broth or bouillon.
    
    
  • Consomme.
    
    
  • Salt-free broth or bouillon which are made with salt substitute (potassium chloride).

What other diet guidelines should I follow?

• Any food that contains liquid, such as soup, must be added in the amount of liquid that you may have each day. Any food that melts when it is not cold, such as gelatin or ice cream, must also be counted.
  
  
• Ask your caregiver if you should make other diet changes because of other health problems you may have. You may need to take a vitamin and mineral supplement (pill). Your caregiver will recommend the right vitamin and mineral supplement for you if you need one.
  
  
• You may need to stop using salt substitutes because they also contain potassium.
  
  
• Eat high fiber foods to avoid becoming constipated. Constipation is having dry, hard stools that are difficult to pass. High fiber foods include vegetables and fruits, whole grains (whole wheat bread and bran cereals) and legumes (beans, lentils). Eat only the amounts of high fiber foods suggested by your caregiver to avoid getting too much potassium, phosphorus and sodium.

Risks:

• Following a dialysis diet may cause you to lose interest in eating. This may happen because foods may taste different than they used to. It may also happen because you will not be able to eat certain favorite foods. If you do not eat enough food, your body may not get the calories, protein, and other nutrients you need to be healthy. Talk to your caregiver if you lose interest in eating.
  
  
• Not following a dialysis diet may cause malnutrition (your body does not get the right amount of nutrients to work properly). You may have trouble controlling your blood pressure and balancing blood chemicals and fluids. You may also develop other health problems.
  
  
• Some over-the-counter vitamin and mineral supplements can be harmful if you are on dialysis. Take only the vitamin and mineral supplements suggested or ordered by your doctor.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your diet. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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